Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries

Riki Tesler, Sharon Barak, Orna Reges, Concepción Moreno-Maldonado, Rotem Maor, Tânia Gaspar, Oya Ercan, Yael Sela, Gizell Green, Avi Zigdon, Adilson Marques, Kwok Ng, Yossi Harel-Fisch

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, oneway analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate-and high-risk adolescents is crucial.

Original languageEnglish
Article number268
JournalHealthcare (Switzerland)
Issue number2
StatePublished - 29 Jan 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


Funding: This research was funded by grants from them ministries of health, education, and public security. The Israel HBSC research team is supported by the Department of Health. Funding number: 430/21.

FundersFunder number
Department of Health and Social Care430/21


    • Cardiovascular risk factors
    • Cluster analysis
    • Lifestyle behavior
    • Youth


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